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Performance of the Dutch clinical prediction rule for the ambulation outcome after spinal cord injury in a middle-income country clinical setting: an external validation study in the Thai retrospective cohort

Spinal Cord volume 61, pages 608–614 (2023)Cite this article

Subjects

Abstract

Objective

To perform external geographic and domain validation of the clinical prediction rule (CPR) of the ambulation outcome of patients with traumatic spinal cord injury (SCI) originally developed by van Middendorp, et al. (2011) in Thais with traumatic and non-traumatic SCI.

Study design

Retrospective cohort study.

Setting

A tertiary rehabilitation facility in Chiang Mai, Thailand.

Methods

A validation data set, including predictive (age and four neurological variables) and outcome (ambulation status) parameters was retrospectively collected from medical records of patients with traumatic and non-traumatic SCI admitted between December 2007 and December 2019. The performance of the original model was evaluated in both discrimination and calibration aspects, using an area under the receiver-operating characteristic curve (auROC) and calibration curves, respectively.

Results

Three hundred and thirty-three patients with SCI were included in the validation set. The prevalence of ambulators was 59% (197 of 333 participants). An auROC of 0.93 (95% CI 0.90–0.96) indicated excellent discrimination whereas the calibration curve demonstrated underestimation, especially in patients with AIS grade D. Performance of the CPR was decreased but acceptable in patients with non-traumatic SCI.

Conclusions

Our external validation study demonstrated excellent discrimination but slightly underestimated calibration of the CPR of ambulation outcome after SCI. Regardless of the geographic and etiologic background of the population, the Dutch CPR could be applied to predict the ambulation outcome in patients with SCI.

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Fig. 1
Fig. 2: A calibration plot demonstrating predictive probabilities (solid line) and observed outcomes (circles) in this validation set.
Fig. 3
Fig. 4

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

SP would like to acknowledge the Swiss Government Excellence Scholarship 2022, postdoctoral fellowship.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Buddharaksa Rajchagool & Sintip Pattanakuhar

  2. Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Pakpoom Wongyikul, Lalita Lumkul & Phichayut Phinyo

  3. Center of Multidisciplinary Technology for Advanced Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Lalita Lumkul

  4. Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Phichayut Phinyo

  5. Health Services and Clinical Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland

    Sintip Pattanakuhar

Authors
  1. Buddharaksa Rajchagool
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  3. Lalita Lumkul
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  4. Phichayut Phinyo
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  5. Sintip Pattanakuhar
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Contributions

BR designed the research question, collected and analyzed the data, and wrote the preliminary version of the manuscripts. PW, LL, and PP designed the research question, analyzed the data, and revised the final version of the manuscripts. SP designed the research question, analyzed the data, wrote the preliminary version, and revised the final version of the manuscripts.

Corresponding author

Correspondence to Sintip Pattanakuhar.

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Competing interests

The authors declare no competing interests.

Ethics approval

We certify that the protocol of this analysis was approved by The Research Ethics Committee, Faculty of Medicine, Chiang Mai University (Research ID: REH256307168 / Study code: REH256307168).

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Rajchagool, B., Wongyikul, P., Lumkul, L. et al. Performance of the Dutch clinical prediction rule for the ambulation outcome after spinal cord injury in a middle-income country clinical setting: an external validation study in the Thai retrospective cohort. Spinal Cord 61, 608–614 (2023). https://doi.org/10.1038/s41393-023-00917-y

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